Healthcare Provider Details

I. General information

NPI: 1457266371
Provider Name (Legal Business Name): SHADED S WELLNESS AND SUPERVISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51797 S COUNTY ROAD 203
SHARON OK
73857-5076
US

IV. Provider business mailing address

51797 S COUNTY ROAD 203
SHARON OK
73857-5076
US

V. Phone/Fax

Practice location:
  • Phone: 580-334-7106
  • Fax: 580-334-7106
Mailing address:
  • Phone: 580-334-7106
  • Fax: 580-334-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KYLENE SHARPTON
Title or Position: OWNER
Credential: LCSW
Phone: 580-334-7106